The ApoB/LDL-C Ratio Predicts Major Cardiovascular Events in Cardiovascular Disease Patients independently of Type 2 Diabetes Status

A high ApoB/LDL-C ratio reflects small LDL particle size which like type 2 diabetes (T2DM) is associated with insulin resistance. Whether the ApoB/LDL ratio and the presence of T2DM are mutually independent predictors of major cardiovascular events (MACE) is unclear and is addressed in the present study. We enrolled a large high risk cohort of 1689 patients with established cardiovascular disease (1391 patients with angiographically proven stable CAD and 298 patients with sonographically proven peripheral artery disease). T2DM was diagnosed according to current ADA guidelines. Prospectively, MACE including death from cardiovascular cause, non-fatal stroke and non-fatal myocardial infarction were recorded over a mean follow-up period of 9.6±5.1 years. At baseline, the ApoB/LDL-C ratio was significantly higher in patients with T2DM (n=561) than in subjects who did not have T2DM (0.82±0.19 vs. 0.74±0.15 p<0.001). During follow-up, 668 patients suffered MACE. The Apo B/LDL-C ratio predicted MACE in univariate analysis (HR=1.12 [1.04-1.20] p= 0.002), and the event rate was higher in patients with than in those without T2DM (49.1% vs. 34.9%; p<0.001). In a multivariate adjusted Cox regression model both the ApoB/LDL-C ratio and T2DM significantly predicted MACE in a mutually independent manner, with standardized adjusted HRs of 1.17 [1.05-1.30]; p=0.005 and 1.49 [1.26-1.75]; p<0.001, respectively. We conclude that in subjects with established cardiovascular disease the ApoB/LDL-C and T2DM are mutually independent predictors of MACE. Disclosure B.Larcher: None. C.H.Saely: None. M.Maechler: None. L.Sprenger: None. A.Mader: None. A.Vonbank: None. T.Plattner: None. A.Leiherer: None. A.Muendlein: None. H.Drexel: None.